Transference-countertransference Matrix Research Articles

"How Can I Trust You When I Know You Can Die?" Surviving the Death of an Analyst in a Child Analysis.

This reflection on the initial stages of treatment of a latency girl whose previous analyst died offers some insights into inner workings of mourning in children. The mourning process intersects in complex ways with a developmental stage, object constancy, unconscious phantasies, and conscious ideas about life and death. Clinical material illustrates some challenges that emerge in the transference-countertransference matrix when working with a child who lost both her primary object (the mother) and her transference object (the analyst). The reality of the analyst's death emphasizes that for a child patient the analyst is always a transference object and a real object at once.

ПОЗАСВІДОМЕ ПСИХОАНАЛІТИКАЯК ОБ’ЄКТ ЕМПІРИЧНИХ ДОСЛІДЖЕНЬ(АНАЛІЗ ПУБЛІКАЦІЙ ІЗ БАЗИ SCOPUS ЗА І ПІВРІЧЧЯ 2017 РОКУ)

on the topic of psychoanalyst’s unconsciousness, published in the professional psychoanalytic journals from the Scopus list during the first half of 2017. According to them, out of 447 articles in 22 journals, 17 papers were discovered that contain the results of empirical research on the phenomenology of the functioning and manifestation of psychoanalyst’s unconsciousness. As a result, mostly the empirical part of them is based on clinical cases and interviews with psychoanalysts, training analysts and supervisors. In them, in particular, we discovered three general groups of key concepts that are the most relevant subjects of study during the specified period: countertransference, reverie and unconscious communication. A brief overview of the introduced categories in each group is described, for example: transference-countertransference matrix, narcissistic needs of the psychoanalyst, analytic eroticism, experiences regarding to the end of psychoanalysis, silence and numbness of psychoanalysts, unconscious fantasy and unconscious intersubjectivity. The conclusions generalize that the psychoanalyst’s unconsciousness and phenomenology of its manifestation in analytical work remains in the constant focus of research carried out in various psychoanalytic approaches, covering not only direct clinical practice (including those with specific categories of analyzers), but also training analysis and supervisor's assessment. The classical and lacanian schools are more focused on the study of countertransference, the British school – the reveries and unconscious imagination, the intersubjectivists are interested in the study on the ability of the psychoanalyst to use his or her unconsciousness in creating a special intersubjective reality between him or her and the analyst. Unity in the views of a psychoanalyst’s unconsciousness is noted in the ideas about its sensitivity, the diagnostic value of the experiences arising in the sessions, as well as the danger of neglecting the influence of his own unconscious on the psychoanalytic process.

Where the Holocaust and Al-Nakba Met: Radioactive identifications and the psychoanalytic frame

The author, who is of Palestinian heritage, revisits her treatment with a Jewish analyst, who is the offspring of Holocaust survivors. She demonstrates how the transference-countertransference matrix was both constructed and compromised by politics and intergenerational trauma, some aspects of which remained unconscious, others conscious; some of which were enacted, others analyzed. The analytic scene was a microcosm of world events in which “radioactive identifications” (Gampel, 1993, 1998; Gampel and Mazor, 2004) with political and historical issues affected the psychoanalytic situation, resulting in repeated enactments and, finally, an impasse that led to the premature termination of the treatment.

In the margins: Art therapy with a homeless man under the influence of alcohol

This article presents a case study of short-term art therapy with a homeless man that was undertaken in a residential hostel by a trainee therapist. One of the features of this work was that the client was an alcoholic who came to his sessions in varying degrees of intoxication. Although this presented some challenges the authors argue that his engagement in a therapeutic process had meaning that could be understood through a clinical witnessing of enactments within the transference-countertransference matrix. This required paying close attention to countertransference phenomena as expressed through the trainee therapist’s art responses to sessions, which were explored in supervision. Keywords: homelessness, alcohol dependency, witnessing, art therapy, art therapy training, clinical supervision.

THE "METHOD OF GAME": SÁNDOR FERENCZI AND HIS PATIENT DM./CLARA THOMPSON.

The aim of this paper is to study the Thompson-Ferenczi therapeutic relationship. Ferenczi paid increasing attention to the way in which patient's early life experiences were reenacted in the transference countertransference matrix. Ferenczi's (1931) description of how he "entered into a game" with a patient, has come to be known as enactment. Ferenczi exchanged the word "game" with "play" when patients enacted their past traumatic experiences in analysis. These enactments uncovered the unconscious "dialogue of the game" (Ferenczi, 1932, p. 130), and Ferenczi described them in his Clinical Diary (1932) in his work with Thompson. Using the language of her analyst in describing enactment, Thompson referred to Ferenczi's Relaxation Method as his "play technique". During these moments of "play" Thompson argues that the analyst cooperates with the patient in allowing him to relive "childish attachments" in the context of the treatment.

Psychotherapy with People who have Disorganised Attachment Patterns in a Psychodynamic and Attachment Theory Informed Setting

The story of my work with a woman who has a dissociative disorder is presented from an attachment perspective. Someone with a disorganised/disoriented attachment status requires a different approach. Within an attachment and psychoanalytic psychotherapy approach I describe how by centring on issues of selfregulation (dissociative withdrawal) and interactive regulation, when the patient was in a highly helpless and frightened state, an enactment emerged that mirrored the interactions she had had with her parents. Within our growing mutual understanding of the mosaic of the transference–countertransference matrix a pattern was discernible: each time the therapist felt pressured to act she was caught in a repetition of earlier frightening and perverse relationships. Thinking and reflecting on these enactments enabled the patient to differentiate between past and present and helped her to verbalise her unmentalized feelings.

The Broken Self: Injured States in The Transference-Countertransference Matrix.

Themes of injury and injuredness reverberate throughout the treatment of patients categorized as having disorders of the self. Aspects of the various identifications that these patients may make with clinicians who are visibly physically handicapped from the outset of treatment are explored. Vignettes from psychoanalytically informed psychotherapies conducted at frequencies of up to three times weekly reveal how these identifications are used to externalize a sense of internal psychic impairment and to shed defective introjects in an attempt to preserve a faltering self. Themes of injury and defectiveness resonate throughout the transference-countertransference matrix, leading either to a working through of the injured state or, in unfortunate cases, to the disabling of the treatment itself. Particular attention is paid to patients who reveal during treatment that they were raised by a physically ill or handicapped parent and are therefore particularly vulnerable to castrative or disintegrative anxiety. Implications for the use of the able-bodied clinician by such patients are also considered, as well as the use of the clinician's injuredness by less primitively organized patients. The limitations of these treatments are also addressed.

Reclaiming Lost Loves: Transcending Unrequited Desires. Discussion of Davies’ “Oedipal Complexity”

In this discussion I address the multidimensionality embedded within the oedipal phase of development and contend that the elaboration and working through of unrequited oedipal longing within the transference–countertransference matrix is one of the most profound gifts of an analysis. The child’s confrontation with thwarted desire (generationally) for either parent is central to the development of the mind, the personality, and one’s erotic life. I also argue that the experience of oedipal exclusion becomes not solely a response to a generational boundary but to a gender boundary discouraging same-sex love. I speak for retaining a conceptualization of an oedipal complex without losing any of the complexity of individual experience. In describing our oedipal lineages for erotic life as resting upon an interwoven layering of maternal and paternal oedipal desires, my aim is to continue a project to rehabilitate the oedipal concept from heteronormative presumptions and from being (mis)understood in a reductive manner that alienates rather than engages.

Relational Theory: A Refuge and Compass

Relational theory offers a structure from which to understand and treat the interpersonal and intrapsychic legacy of severe childhood trauma. During the course of treatment, particularly with such traumatized patients, therapists are challenged to tolerate and make meaning of intense feelings in the transference-countertransference matrix. Relational theory’s ideas regarding adaptation to and perpetuation of the relational patterns of early life, dissociation of disavowed and intolerable self-states, and the inevitability of mutual enactments provide an organizing framework in which to weather and make bearable the unbearable. In addition, relational theory invites and supports the clinician in the vital task of meeting the patient’s vulnerability with his or her own authentic and vulnerable self. The following case material demonstrates the use of relational theory to find and to work at the intimate edge (Ehrenberg in Relational psychoanalysis: innovation and expansion, Analytic Press, Hillsdale, pp 3–28, 2005) where the impossible becomes possible.

Moments of Loneliness: A Shared Experience of Learning from Impasse in Couple Therapy

In this paper, the author describes how she works with two theoretical ideas not commonly referred to by couple therapists: Klein's views on loneliness and Bion and O'Shaughnessy's concept of the absent object. She also weaves in Winnicott's theory of how the baby develops the capacity to be alone. Theoretically, her ideas are embedded in the British Object Relations School as well as her experiences as a couple and family therapist, a teacher of the Tavistock model of infant and young child observation, and day-to-day practice as a psychoanalyst. The author illustrates how she works within the transference-countertransference matrix to detect and name disturbing moments of loneliness. Clinical vignettes show how couples are assisted in uncovering the unconscious phantasies that push them into mutually hostile states of mind and which, in an instant, destroy feelings of goodness within and between them. While the author focuses on her work with couples, the approach is applicable in many clinical situations.

Transference-countertransference repetitions of traumatic affects

Some patients defend against all affective experiencing, which limits their ability to process feelings verbally. When they establish such defenses to cope with early traumatic experiences, they may need to repeat the affective tone of these experiences within the transference. Using case material, the author explore ways that therapists can utilize the transference-countertransference matrix--particularly their own affective responses in the hour--to help patients to know these experiences.

The New Emerges Out of the Old

This article considers how new ways in which a client and therapist relate emerge out of old ways the client related to others, with the subsequent transformation of maladaptive schemas and ego state relational units (Little, 2006) into more adaptive schemas. The author explores the nature of the client’s pathology and maladaptive relational schemas and the therapeutic action that might be transformative for the client. He also examines a modern perspective on the transference-countertransference matrix and explores further the concept of optimal neutrality.

“Strange and Otherwise Unaccountable Actions”

Despite recognizing that gender identity is a complex compromise formation, psychotherapists struggle to tolerate gender variance. We still tend to favor binary gender identities and clear developmental lines, rather than embracing a stance of subversive curiosity about the variability and fluidity of gender in our patients. When gender identity is fluid or ambiguous, countertransferential affective disturbances can arise that meld states of abjection and excitement, challenging theoretical constructs and threatening therapeutic neutrality. Case material from the treatment of a female-to-male trans person is presented from the perspective of the transference-countertransference matrix.

Are You Thinking (But Not Saying) What I'm Thinking (But Not Saying)? On Not Interpreting: The Role of the Analyst's Theory: Reply to Commentaries

In response to these very generous commentaries by Donnel B. Stern and Pat Ogden, I question the meaning and power of the contents of the analyst's mind in the interpretations that are not made. These mental contents are an inevitable amalgam of her theory, her awareness of embodied experience, her understanding of the transference–countertransference matrix, and her moment-to-moment reading of whom she is “being with,” in Stern's formulation. I am extending this formulation, in a Winnicottian sense, and with a fuller integration of the body into the analytic relationship, to more wholly experience whom she is “going on being-with.” The quality of attentiveness that may infuse somatic therapies, like Ogden's, is considered in this light.

When Absence Speaks Louder than Words: An Object Relational Perspective on No-Show Appointments

The rates of no-show appointments in community mental health are reported to be as high as 50%. Yet there is a striking scarcity of clinical literature on this subject compared with the abundance of articles written from an administrative point of view. This paper describes a variety of countertransference responses to missed appointments. Drawing from object relations theory, the author maps out different pathways to guide thinking about the use of countertransference, listening to clinical material following a no-show appointment, and responding to organizational pressures. The paper aims to help practitioners make greater sense of the patient’s inner world and of what is going on in the transference-countertransference matrix.

Impasse Clarification within the Transference-Countertransference Matrix

This article describes a relational approach to deconfusion of Child-Parent ego state relational units, with particular emphasis on the client's experience of the impasse between him or her and the therapist in terms of the repeated relationship and the needed relationship. The repeated relationship represents the repetitive dimension of the transference, while the needed relationship represents the self-object and developmental arrest facet of the transference. The author also makes reference to and differentiates the therapeutically required relationship.

Performative and enactive features of psychoanalytic witnessing: The transference as the scene of address

This paper will attempt to broaden the conception of witnessing in analytic work with traumatized patients by extending the idea to incorporate the patient’s developing and varied capacity for witnessing, as well as a witnessing that occurs within the analytic relationship itself. Actions occuring as part of traumatic repetition are understood to represent memory phenomena and are distinguised from dissociated self‐state experience. These experiences are not therapeutically intended to be symbolized, but rather lived‐through with the analyst, thus transforming the patient’s own relation to the experience. I suggest that the scene in which this living‐through takes place is the transference–countertransference matrix, and that it is the analytic encounter that allows traumatic repetition to take on the quality of a communication, an address to another, rather than remain meaningless reproduction. A clinical vignette illustrates the turning of trauma’s imperative for witnessing into an address in the analytic encounter.

Inside Out: The State of the Analyst and the State of the Patient

This paper presents my work with a man before and after my undergoing an emergency, life-threatening surgical episode, and subsequent experience of living with a temporary colostomy, that shifted me to a more ungrounded, bodily aware, vulnerable, nonlinear, spontaneous and risk-taking, and affectively intensified “right brain” state. My story represents one instance of how the contingent nature of the analyst's life and existential exposure, and the various chancy life circumstances governing the analyst's self-state, may constitute an impingement on clinical process with potential for inadvertent positive or negative impact on the therapeutic relationship and work. Much has been written about the causes and consequences of shifts in the analyst's self-state induced within the relational dynamics of the transference-countertransference matrix. Here I specifically consider that side of the intersubjective therapeutic equation generated by the effects of the analyst's own state on the patient and the dyad's interactive process.

Managing Transference and Countertransference in the Treatment of Gay, Lesbian and Bisexual Survivors of Childhood Sexual Abuse

ABSTRACT Gay, lesbian and bisexual (GLB) survivors of childhood sexual abuse must endure the detrimental intrapsychic and interpersonal effects of the traumatic abuse as well as societal intolerance and discrimination related to their core identity. The adverse psychological effects of the sexual abuse and specific developmental issues related to a homosexual orientation may be additive in terms of the deleterious impact on the survivor's interpersonal functioning. The relational difficulties these individuals experience will inevitably manifest themselves in the therapeutic relationship via the transference-countertransference matrix. Issues such as shame, trust, and boundaries are some of the clinical themes that may be particularly relevant with this population of survivors. The authors suggest some therapeutic intervention within the context of potential transference-countertransference paradigms.

Out of the Dark The Psychoanalysis of an Adolescent Boy1

The five-year analytic treatment of a troubled and troubling adolescent boy is described. Seth was a depressed and physically aggressive boy with perceptual learning disabilities. The analyst was a middle-aged man with an active style of therapy and a personal history that overlapped with some of Seth's issues. Working within a relational tradition (Altman et al., 2002; Santostefano, 2004), detailed process notes bring to the foreground Seth's demonizing introjections, the transference-countertransference matrix, enactments, mutuality, and intersubjective moments. The actual and embodied meanings of these occurrences is examined and contextualized. 1Invited paper presented at the conference “L'adolscente Relazionale: Prospettive Psicanalitiche Contemporanee.” Rome, Italy. 3 December 2004.